Date of Award

Spring 4-13-2023

Document Type


Degree Name

Doctor of Nursing Practice (DNP)




Dr. Kacy Ballard

First Committee Member

Dr. Joy Shoemaker

Second Committee Member

Dr. Amy Bishop


Keywords: Mastectomy, Radical, Modified Radical, PECS block, TPVB, pain

Subject Categories

Anesthesiology | Medicine and Health Sciences | Musculoskeletal, Neural, and Ocular Physiology | Oncology | Quality Improvement


Patients undergoing a mastectomy are at increased risk of becoming opioid dependent. Most patients undergoing a mastectomy are diagnosed with breast cancer, and the use of opioids is known to aid in cancer metastasizing due to the suppression of the body's natural killer cells. In addition, regional anesthesia, also known as a nerve block, has long provided a reduction in sensation by blocking the nerve pathway, thus numbing the feeling of pain in the operative area. The Pectoralis nerve block (PECS) and the Thoracic Paravertebral block (TPVB) are used in patients undergoing a mastectomy to help reduce the severity of pain that the body perceives. These nerve block aid in the reduction of supplemental analgesia postoperatively, allowing a lower number of opioids to be consumed. The project's primary purpose is the development of evidence-based clinical recommendations which can be utilized to reduce the intensity of perceived pain for patients undergoing a mastectomy. The recommendations will be determined by selecting which nerve block provides the most significant reduction in the visual acuity scale (VAS) score. Along with the longest time from when the surgery is completed to when the patient first asks for supplemental analgesia by comparing multiple randomized control trial articles comparing the two nerve blocks. The project includes a plan for implementing these evidence-based practice recommendations through education and training, monitoring outcomes, and providing changes to the recommendations if the results are not desirable.

Acknowledgement 1


Acknowledgement 2


Licensing Permission

Copyright, all rights reserved. Fair Use



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